Coolspring Power Museum, Memberhip Form, Hit Miss Engines

Coolspring Power Museum

Membership/Contribution Form

Company Name: ____________________________________	Home Phone: ______________________
Name: ____________________________________	E-mail: ______________________
Street: ____________________________________	2nd E-Mail: ______________________
City: ____________________________________	Cell Phone: ______________________
State: ____________ Country: ______________	Work Phone: ______________________
ZIP code or International Code: ______________	Fax: ______________________
Do you wish your name to be kept confidential? If you answer yes, your name will not be printed in the museum's Friends Directory: (Yes or No):_________
Expertise/Occupation/Skill you could volunteer to the museum:___________________________________
_______________________________________________________________________________________

Please check one:
*ANNUAL MEMBERSHIPS DUES*	*LIFE MEMBERSHIPS DUES - One Time Contribution*
Annual Friend Dues - $30	Patron $1,000
Annual Family Friend Dues - $40	Cornerstone Patron $5,000 - $9,999
	Endowment Patron $10,000 and up

Membership Dues Amount from Above	$
Additional Amount for the General Operating Fund	$
Additional Amount for the 600 hp Snow Fund	$
Additional Amount for the Endowment Fund	$
International Processing Fee*	$
Other	$
Total Enclosed	$

Send with remittance to:

Coolspring Power Museum
c/o Gail Lavender
179 Coolspring Road
Coolspring, PA 15730

The official registration and financial information of Coolspring Power Museum may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.

*International Members: Please add a $15 fee to cover the fee our bank charges
to process your non-US$ checks.